肺炎鏈球菌多醣體疫苗於糖尿病75歲以上老人 之效果

Abstract

目的 糖尿病是常見慢性病，也是重大公共衛生負擔，糖尿病已被發現和許多肺炎鏈球菌感染疾病有關，而23價肺炎鏈球菌多醣體疫苗(23-valent pneumococcal polysaccharide vaccine, PPV23)在糖尿病患及老年人身上，被建議施打以預防肺炎鏈球菌感染。然而，糖尿病和年齡皆被發現和免疫功能異常有關，這些免疫功能異常是否會進一步影響PPV23於糖尿病老人身上的成效，是本研究想要探討的主題。 方法 本研究為回溯性巢狀世代研究，我們利用健保資料庫找出2000到2009年間糖尿病75歲以上老人，除了接受PPV23的暴露世代，也用傾向分數配對的方式找出對照世代，來比較兩組間的肺炎鏈球菌感染相關疾病、以及醫療利用情形，也試著做次族群分析來探討流感疫苗施打對結果的影響。 結果 施打PPV23可以帶來較少的侵襲性肺炎鏈球菌疾病(IPD)(adjusted OR: 0.85, 95% CI: 0.78-0.93)、較少住院(0.96, 0.93-0.99)、較少發生嚴重併發症 (0.88, 0.82-0.85)、以及較短住院天數(0.58 ± 0.19天). 在有施打流感疫苗組內，施打PPV23相較於沒有施打PPV23，有較少的侵襲性肺炎鏈球菌疾病(IPD)、較少住院、較少發生嚴重併發症、較短住院天數、以及較少的醫療花費。在未施打流感疫苗組內，施打PPV23相較於沒有施打PPV23，有造成較少的侵襲性肺炎鏈球菌疾病(IPD)以及較少發生嚴重併發症。施打PPV23和流感組，相較於只施打PPV23組，發生全原因肺炎、住院、急診就診以及嚴重併發症的危險性較低。 結論 在75歲以上的糖尿病老人施打PPV23，可以預防肺炎鏈球菌相關疾病、也可以減少醫療利用。施打PPV23和流感族群，相較於只施打PPV23族群，能有加成性助益。

Abstract: OBJECTIVE Diabetes mellitus is associated with increased risk of pneumonia, and 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for prevention of pneumonia. However, the effectiveness of PPV23 remains unclear in the older diabetic patients who usually have compromised immune function. RESEARCH DESIGN AND METHODS We used data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) from 2000 to 2009 to conduct a population-based retrospective cohort study, comparing the incidence of pneumococcal diseases among PPV23-vaccinated and propensity-score matched PPV23-unvaccinated groups in diabetic elderly. The primary outcomes were pneumococcal diseases, and the secondary outcomes were medical utilization. RESULTS PPV23-vaccinated group had reduced risks of invasive pneumococcal disease (IPD) (adjusted OR: 0.85, 95% CI: 0.78-0.93), hospitalization (0.96, 0.93-0.99), severe complications (0.88, 0.82-0.85), and shorter length of hospitalization (0.58 ± 0.19 days). In flu-vaccinated group, subjects who received PPV23 had reduced risks of IPD, hospitalization, severe complications, shorter lengths of hospitalization, and less medical costs, than those without receiving PPV23. In not flu-vaccinated group, PPV23 vaccination was associated with reduced risks of IPD and severe complications. Concomitant influenza and PPV23 and influenza vaccination could bring synergistic protection in all-cause pneumonia, admission, visits of emergency department, and severe complications. CONCLUSIONS PPV23 vaccination was effective in prevention of pneumococcal diseases and reduction of medical utilization in diabetic elderly aged 75 and more. Concomitant PPV23 and influenza vaccination resulted in better outcomes than PPV vaccination alone.